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ABBEY MSII Unit 1 > Goljy Female Reproductive. > Flashcards

Goljy Female Reproductive. Flashcards

1
Q

MCCC bartholin gland abscess

A

neisseria gonorrhea

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2
Q

thinning of epidermis of vulva in post-menopausal women resulting in parchment-like appearance of skin

A

lichen sclerosis

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3
Q

white plaque like lesion on vulva due to squamous cell hyperplasia

A

lichen simplex chronicus

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4
Q

benign tumor of apocrine sweat gland forming a painful nodule on labia majora

A

papillary hidradenoma

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5
Q

vulvar intraepithelial neoplasia

A

associated with HPV 16 –> precursor for developing squamous cell carcinoma

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6
Q

MC malignancy of vulva

A

squamous cell carcinoma

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7
Q

risk factors for squamous cell carcinoma of vulva

A

HPV 16, smoking, immunodeficiency

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8
Q

red, crusted vulvar lesion that is a type of intraepithelial adenocarcinoma with PAS+ cells that spreads along the epithelium, rarely invading the dermis

A

extramammary Paget’s disease

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9
Q

which other type of cells histologically resemble paget’s cells?

A

melanoma cells –> but they are PAS negative

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10
Q

an anatomic cause of primary amenorrhea, with absence of the upper vagina and uterus?

A

Rokitansky-Kuster-Hauser syndrome

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11
Q

a remnant of the the Wolffian (mesonephric) duct that presents as a cyst on the lateral wall of vagina

A

Gartner’ duct cyst

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12
Q

benign tumor of skeletal muscle that can be found in vagina, tongue or heart?

A

rhabdomyosarcoma

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13
Q

grape-like mass protruding from the vagina in young girls (

A

embryonal rhabdoymyosarcoma aka. sarcoma botyroides

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14
Q

which cancer occurs in women with intrauterine exposure to diethylstilbestrol?

A

clear cell adenocarcinoma of vagina

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15
Q

red, superficial ulcerations in upper vagina due to remnants of mullerian glands

A

vaginal adenosis –> precursor lesion for clear cell adenocarcinoma

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16
Q

besides clear cell carcinoma, what are some other abnormalities caused by DES?

A

abnormally shaped uterus that thwarts implantation; cervical incompetence - recurrent abortions

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17
Q

transformation zone in cervix

A

site where squamous dysplasia and cancer develop –> site sampled during a PAP smear

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18
Q

nabothian cysts

A

obstruction of outflow of mucus from endocervical glands due to blockage by metaplastic squamous cells

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19
Q

causative agents of acute cervicitis

A

Chlamydia and Neisseria gonorrhea = > 50% of cases, trichomonad vaginalis, candida, herpes simplex virus (HSV2), HPV

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20
Q

clinical findings in acute cervicitis

A

vaginal discharge - MC, pelvic pain, dyspareunia, painful on palpation, bleeds easily during cultures, cervical os is erythematous and covered by exudate

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21
Q

follicular cervicitis

A

C.trachomatis infects metaplastic squamous cells - cells contain vacuoles w/ red inclusions (reticulate bodies) which develop into elementary bodies (infective particles)

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22
Q

primary source of conjunctivitis and pneumonia in newborns?

A

Chlamydia trachomatis cervicitis

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23
Q

purpose of PAP smear

A

screen test to R/O squamous dysplasia and cancer, evaluates the hormone status of patient

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24
Q

superficial squamous cells on Pap smear

A

adequate estrogen, - 100% of these cells in women with continuous exposure to estrogen without P4

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25
Q

intermediate squamous cells on Pap

A

adequate progesterone - 100% of these cells seen in pregnant women

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26
Q

parabasal cells on Pap smear

A

lack of estrogen and P4 - usually in elderly women

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27
Q

non-neoplastic polyp that protrudes from endocervix on cervical os commonly seen in perimenopausal and multigravida women between age 30-50

A

cervical polyp - not precancerous

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28
Q

clinical findings with a cervical polyp

A

postcoital bleeding; vaginal discharge

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29
Q

koilocytosis

A

clear halo containing a wrinkled, pyknotic nucleus –> effect of HPV on squamous cells

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30
Q

risk factors for cervical intraepithelial neoplasia (CIN)

A

early age at onset of sexual intercourse; multiple, high risk partners; HPV 16, 18; smoking, OCPs, immunodeficiency

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31
Q

CIN 1

A

mild dysplasia involving the lower 1/3 of epithelium

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32
Q

CIN 2

A

moderate dysplasia involving lower 2/3 of epithelium

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33
Q

CIN 3

A

severe dysplasia –> carcinoma in situ involving the full thickness of epithelium

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34
Q

appearance of CIN on colposcopy

A

acetowhite areas with punctuation, mosaic pattern or abnormal vascularity

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35
Q

what type of cancer is cervical cancer?

A

mostly squamous cell carcinoma –> small cell and adenocarcinoma are less common

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36
Q

clinical findings in cervical cancer

A

abnormal vaginal bleeding - esp. post coital; malodorous discharge

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37
Q

MCC of death in cervical cancer

A

postrenal azotemia causing renal failure

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38
Q

sequence to menarche

A

breast budding, growth spurt, pubic hair, axillary hair, menarche

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39
Q

proliferative phase of menstrual cycle

A

follicular phase –> estrogen mediated, most variable phase

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40
Q

secretory phase of menstrual cycle

A

luteal phase –> progesterone mediated, increased pland turtuosity, edema of stromal cells

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41
Q

Arias-Stella phenomenon

A

exaggerated secretory phase that occurs in pregnancy

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42
Q

what initiates menses?

A

drop in serum levels of estrogen and P4 if fertilization does not occur –> plasmin prevents menstrual blood from clotting

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43
Q

functions of FSH (3)

A
  1. prepares follicle 2. aromatase synthesis in granulosa cells 3. synthesis of LH receptors
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44
Q

functions of LH in proliferative phase

A

increases synthesis of 17-ketosteroids in theca interna to synthesize testosterone for conversion by aromate to estradiol in granulosa cells

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45
Q

functions of LH in secretory phase

A

theca interna synthesizes 17-OH progesterone

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46
Q

functions of hCG

A

synthesized by syncitiotrophoblast and acts as an LH analogue by maintaining the corpus luteum during pregnancy

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47
Q

primary estrogen in non-pregnant women

A

estradiol

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48
Q

estrogen of postmenopausal women

A

estrone –> derived from adipose cell aromatization of androstenedione

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49
Q

primary estrogen of pregnancy

A

estriol –> from fetal adrenal, placenta and maternal liver

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50
Q

androstenedione

A

derived from ovaries and adrenal cortex

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51
Q

DHEA

A

mainly synthesized in adrenal cortex (remainder in ovaries)

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52
Q

DHEA-sulfate

A

made exclusively in the adrenal cortex

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53
Q

where is testosterone made?

A

synthesized in ovaries and adrenal glands

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54
Q

definition: menopause

A

no menses for 1 year after age 40

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55
Q

causes of menopause

A

physiologic, surgical removal/radiation of ovaries, Turner’s syndrome, family history of early menopause, left-handedness

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56
Q

clinical findings in menopause

A

secondary amenorrhea; hot flushes, night sweats, atrophic veginitis; mood swings, anxiety, depression, insomnia, decreased libido, urinary incontinence, headaches, tiredness, lethary, osteoporosis

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57
Q

best marker for menopause

A

serum FSH –> increased

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58
Q

excess hair in normal hair-bearing sites

A

hirsutism

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59
Q

hirsutism + male secondary sex characteristics

A

virilization

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60
Q

male secondary sex characteristics

A

increased muscle mass, acne, enlarged clitoris –> most impt finding

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61
Q

cause of hirsutism/virilization

A

hyperandrogenicity of ovarian, adrenal or drug origin

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62
Q

MCC of hirsutism

A

polycystic ovary syndrome

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63
Q

an obese female presents to you with hirsutism, oligomenorrhea and questions her fertility – most probable diagnosis?

A

PCOS

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64
Q

lab findings in PCOS

A

LH:FSH ratio > 2; increased serum testosterone and androstenedione; increased serum estrogen

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65
Q

women with PCOS have an increased risk for..

A

endometrial cancer

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66
Q

treatment of PCOS

A

weight reduction, low dose OCPs or medroxyprogesterone, spironolactone is OCPs unacceptable, LH-releasing hormone analogues

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67
Q

menorrhagia

A

loss of > 80 ml of blood per period –> likely if staining sheets at night with heavy protection and excessive passage of clotsp

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68
Q

primary dysmenorrhea

A

painful menses that occurs only in ovulatory cycles due to increased PGF2 which increases uterine contractions

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69
Q

secondary dysmenorrhea

A

painful menses due to endometriosis (MC), adenomyosis, leiomyomas and cervical stenosis

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70
Q

metorrhagia

A

excessive flow and duration at irregular intervals

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71
Q

oligomenorrhea

A

intervals > 35 days

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72
Q

polymenorrhea

A

intervals

73
Q

90% of abnomal bleeding is caused by…

A

anovulation –> majority of cases are postmenarchal and perimenopausal (MC)

74
Q

MCC of anovulatory dysfunctional uterine bleeding

A

excessive estrogen stimulation in relation to P4 = absent secretory phase of cycle, producing endometrial hyperplasia and excessive bleeding

75
Q

causes of ovulatory dysfunctional uterine bleeding

A

(1) inadequate luteal phase (decreased P4) (2) irregular shedding of endometrium (persistent luteal phase)

76
Q

absence of menses by age 16

A

primary amenorrhea

77
Q

absence of menses for 3 months

A

secondary amenorrhea –> usually due to pregnancy

78
Q

primary amenorrhea + poor female secondary sex characteristics

A

probable Turner’s syndrome

79
Q

Asherman syndrome

A

removal of stratum basalis owing to repeated curretage –> caused of end-organ defect amenorrhea

80
Q

uterine infection following delivery (vaginal/cesarean section) or abortion usually caused by group B streptococcus

A

endometritis

81
Q

patient who just delivered a baby presents to you with fever, uterine tenderness, foul vaginal discharge and abdominal pain - diagnosis?

A

endometritis

82
Q

treatment of endometritis

A

cefoxitin, ticarcillin-clavulanate, ampicillin-sulbactam

83
Q

causes of chronic endometritis

A

retained placenta, gonorrhea, intrauterine device - actinomyces israelii

84
Q

key histologic finding for chronic endometritis on biopsy

A

presence of plasma cells

85
Q

invagination of stratum basalis into the myometrium with glands and stroma present in the myometrium producing uterine enlargement

A

adenomyosis

86
Q

clinical findings in adenomyosis

A

menorrhagia, dysmenorrhea, pelvic pain

87
Q

functioning glands and stroma located outside the uterus

A

endometriosis

88
Q

pathogenesis of endometriosis

A
  1. reverse menses through fallopain tubes w/ implantation of viable endometrial cells 2. coelemic metaplasia 3. vascular or lymphatic spread
89
Q

common sites for endometriosis

A

ovaries, rectal pouch of douglas, fallopian tubes, intestine

90
Q

rectal pouch of Douglas

A

anterior to rectum and posterior to uterus –> can be palpated on DRE in females –> site for collection of blood, malignant cells, pus and endometrial implants

91
Q

clinical findings in endometriosis

A

dysmenorrhea, menorrhagia, painful stooling during menses, infertility, dyspareunia, increased risk of ectopic pregnancy, enlargement of ovaries with blood-filled cysts

92
Q

common cause of menorrhagia in 20-40 year olds with spotting between menstrual periods or after menopause

A

endometrial polyp - - benign, enlarged with estrogen stimulation

93
Q

risk factors for endometrial hyperplasia

A
  1. early menarche, late menopause 2. nulliparity
  2. obesity
  3. PCOS
  4. estrogen replacement therapy
  5. anovulatory menstrual cycles
  6. HNPCC
94
Q

clinical findings in endometrial hyperplasia

A

postmenopausal bleeding

95
Q

MC gynecologic cancer

A

endometrial carcinoma

96
Q

risk factors for endometrial carcinoma

A

prolonged estrogen stimulation, OCPs decrease risk due to opposing effect of progestin

97
Q

adenoacanthoma

A

endometrial adenocarcinoma that contains foci of benign squamous tissue (no prognostic significance)

98
Q

adenosquamous carcinoma

A

endometrial adenocarcinoma with foci of malignant squamous cells (worse prognosis)

99
Q

papillary adenocarcinoma

A

highly aggressive form of endometrial cancer

100
Q

most common finding in endometrial carcinoma

A

postmenopausal bleeding

101
Q

MC benign CT tissue tumor in women

A

leiomyoma “fibroids”

102
Q

clinical findings in leiomyoma

A

menorrhagia, obstructive delivery,
pressure on colon = constipation,
pressure on bladder = urgency, frequency, incontinence

103
Q

MC sarcoma of the uterus

A

leiomyosarcoma –> numerous atypical mitoses and foci of necrosis

104
Q

malignant mixed mullerian tumor (Carcinosarcoma)

A

endometrial adenocarcinoma + malignant mesenchymal (stromal) tumor - bulky, necrotic tumors that often protrude through cervical os

105
Q

carcinosarcomas are associated with..

A

previous irradiation

106
Q

cystic Mullerian remnants located around the fimbriated end of fallopian tube which may undergo torsion causing abdominal pain

A

hydatid cysts of Morgagni

107
Q

MCC of ectopic pregnancy and female infertility

A

pelvic inflammatory disease

108
Q

risk factors for PID

A

multiple sexual partners, vaginal douching,
previous episodes of PID,
unprotected sex

109
Q

MC pathogens causing PID

A

chlamydia trachomatis, neisseria gonorrhea

- in 45% of cases the is co-infection

110
Q

clinical findings in PID

A

fever, lower abdominal pain;
cervical motion, adnexal and uterine tenderness;
abnormal uterine bleeding/discharge;
mucopurulent discharge

111
Q

Fitz-Hughes-Curtis syndrome

A

perihepatitis –> PID extends to infect liver capsule producing RUQ pain

112
Q

treatment of PID

A

ceftriaxone + doxcycline

113
Q

invagination of the mucosa of fallopian tube into the muscle (tubal diverticulosis) that produces nodules in the tube that narrow the lumen

A

salpingitis isthmica nodosa

114
Q

women presents to you with vaginal bleeding, suddent onset pelvic pain and an adnexal mass - most likely diagnosis?

A

ectopic pregnancy

115
Q

implantation of fetus in abnormal location occuring in 1-2% of pregnancies

A

ectopic pregnancy

116
Q

risk factors for ectopic pregnancy

A

MCC = scarring from PID, endometriosis,
altered tubal motility,
progestin only pill,
previous tubal ligation

117
Q

clinical findings in ectopic pregnancy

A

sudden onset of lower abdominal pain and tenderness - usually 6 weeks after normal menstrual period, adnexal tenderness,
rebound tenderness,
abnormal uterine , bleeding
hypovolemic shock

118
Q

MCC of death in early pregnancy

A

ectopic pregnancy rupture with intra-abdominal bleed

119
Q

screening and confirmatory tests for ectopic pregnancy

A

urine B-hCG

120
Q

accumulation of fluid in a follicle or previously ruptured follicle

A

follicular cyst = MC ovarian mass

121
Q

accumulation of fluid in corpus luteum during pregnancy that may be mistaken for an amniotic sac and usually regresses on its own

A

corpus luteum cyst –> MC ovarian mass in pregnancy

122
Q

bilateral ovarian enlargement due to hypercellular ovarian stroma seen in obese post-menopausal women

A

stromal hyperthecosis

123
Q

clinical findings in stromal hyperthecosis

A

hirsutism/virilization, acanthosis nigricans and insulin resistance,
hypertension

124
Q

treatment of stromal hyperthecosis

A

oophorectomy

125
Q

OCPs and pregnancy as risk factors for ovarian cancer

A

decrease risk of surface-derived ovarian tumors due a decreased number of ovulatory cycles

126
Q

MC group of ovarian tumors

A

surface derived ovarian tumors –> Derived from coelomic epithelium and commonly seed the omentum

127
Q

MC benign and malignant germ cell tumors

A

benign = teratoma; malignant = dysgerminoma

128
Q

sex cord stromal tumors

A

hormone producing tumors derived from stromal cells- usually benign

129
Q

MC sign of ovarian tumor

A

abdominal enlargement due to fluid –> malignant ascites, palpable ovarian mass in post-meno women,
malignant pleural effusion,
radiographs showing bones or teeth,
signs of hyperestrinism - bleeding, 100% superficial squamous cells on Pap smear

130
Q

tumor markers for ovarian tumors

A

CA125 –> only increased in surface derived ovarian tumors

131
Q

large multiloculated ovarian tumors lined by mucus-secreting cells whose seeding produces pseudomyxoma peritonei

A

mucinous ovarian tumors

132
Q

mucinous cystadenoma may be associated with…

A

Brenner tumors

133
Q

bilateral malignant ovarian tumors associated with endometrial carcinoma

A

endometroid tumors

134
Q

MC benign germ cell tumor

A

cystic teratoma

135
Q

Rokitansky tubercle

A

nipple like structure in the cyst wall of a cystic teratoma that contains all of the germ layer derivatives

136
Q

MC malignant germ cell tumor

A

dysgerminoma

137
Q

ovarian tumor characterized by an increase in LDH with the same picture as seminoma of testes; associated with streak gonads of Turner’s syndrome

A

dysgerminoma

138
Q

MC ovarian cancer in girls

A

yolk sac tumor

139
Q

benign tumor associated with Meig’s syndrome (Ascites, R-sided pleural effusion) that commonly calcifies

A

thecoma-fibroma

140
Q

low grade malignant feminizing tumor (produces estrogen) that contains Call-Exner bodies

A

granulosa-theca cell tumor

141
Q

benign masculinizing tumor that produces androgens and may contain crystals of Reinke

A

sertoli-leydig tumor

142
Q

malignant tumor with mixture of germ cell tumors (dysgerminoma) and sex-cord stromal tumor associated with abnormal sexual development and commonly calcifies

A

gonadoblastoma

143
Q

tumor containing signet-ring cells from hematogenous spread of a gastric cancer

A

Krukenberg tumor

144
Q

fetal surface of placenta

A

chorionic plate – chorionic villi vessels converge with the umbilical cord; the chorion is covered by the amnion

145
Q

maternal surface of placenta

A

decidua basalis forms cotyledons

146
Q

what does the umbilical cord contain?

A

two umbilical veins (carry oxygenated blood), one umbilical artery (carries deox blood)

147
Q

MC pathogen of placental infections

A

group B strep –> treat with penicillin G or IV ampicillin

148
Q

infection of umbilical cord

A

funisitis

149
Q

chorioamnionitis

A

infection of fetal membranes with danger of neonatal sepsis and meningitis

150
Q

pregnant women presents to you with painless vaginal bleeding in her third trimester.. what can you suspect?

A

placenta previa –> DO NOT do pelvic exam - diagnose via USG

151
Q

pregnant women in her third trimester presents to you with painful vaginal bleeding, forceful uterine contractions and signs of preterm labor; fetal distress is noted – diagnosis?

A

abruptio placentae

152
Q

retroplacental blood clot that seperates the placenta prematurely from its implantation site

A

abruptio placentae

153
Q

MCC of painful late pregnancy bleeding

A

abruptio placentae

154
Q

direct implantation of fetus into myometrium due to defective decidual layer which poses a great risk for hemorrhage during delivery

A

placenta acreta

155
Q

velamentous insertion

A

umbilical cord inserts away from the placental edge - danger of tearing vessels during delivery (usually delivered by c-section)

156
Q

causes of an enlarged placenta

A

Diabetes Mellitus, Rh hemolytic disease of newborn,

congenital syphillis

157
Q

risk factors for pre-eclampsia

A

(1) age 35 yo (2) history of previous preeclampsia
(3) positive family history
(4) blacks
(5) multiple gestations
(6) thrombocytosis
(7) obesity

158
Q

pathogenesis of pre-eclampsia

A

abnormal placentation with decreased vasodilators and increased vasoconstrictors leading to net effect of placental hypoperfusion

159
Q

pathologic findings in pre-eclampsia

A

premature aging of placenta, multiple placental infarctions,

spiral arteries show intimal atherosclerosis

160
Q

preeclampsia + seizures

A

eclampsia

161
Q

clinical findings in preeclampsia

A

hypertension, proteinuria in nephrotic range,
pitting edema,
weight gain > 4 lbs/week,
generalized seizures,
renal disease - swollen endothelial cells, oliguria,
RUQ pain and hepatomegaly

162
Q

HELLP syndrome

A

Hemolysis, Elevated LFTs,
Low Platelets,
–> hemolytic anemia and DIC

163
Q

benign tumor of chorionic villus

A

hydatidiform mole

164
Q

patient presents to you in 4th or 5th month of pregnancy with painless vaginal bleeding and severe vomiting, you notice her uterus is too large and her hCG levels are too high for gestational age

A

complete hydatidiform mole

165
Q

USG appearance of complete hydatidiform mole

A

snow storm appearance with no fetus during 1st sonogram

166
Q

complete hydatidiform mole

A

entire placenta is neoplastic with dilated, swollen villi without fetal blood vessels; no embyro is present

167
Q

treatment of complete hydatidiform mole

A

dilation and curretage –> must remove all material

168
Q

malignant tumor composed to syncitiotrophoblast and cytotrophoblast with the absence of chorionic villi

A

choriocarcinoma

169
Q

risk factors for choriocarcinoma

A

complete mole, spontaneous abortion,

normal pregnancy

170
Q

causes of polyhydraminos

A

tracheoesophageal fistula, duodenal atresia,
maternal diabetes - fetal polyuria,
anencephaly

171
Q

causes of oligohydraminos

A

juvenile polycystic kidney disease, fetal genitourinary obstruction,
ureteroplacental insufficiency,
premature rupture of membranes

172
Q

increased maternal AFP in pregnancy

A

open neural tube defect

173
Q

decreased maternal AFP in pregnancy

A

Downs

174
Q

lecithin:sphinomyelin ratio that indicated adequate surfactant

A

L:S ratio > 2

175
Q

which hormones can be given to mom to increase surfactant synthesis in baby?

A

cortisol, thyroxine

176
Q

which hormones inhibit surfactant synthesis in baby?

A

insulin

177
Q

decreased levels of estriol in pregnancy

A

sign of fetal-maternal-placental dysfunction

178
Q

triple screen in Down’s syndrome

A

decreased urine estriol, decreased serum AFP,

increased serum B-hCG

ABBEY MSII Unit 1 (4 decks)

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